Current knowledge ofBartonella species

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Abstract
Bartonella species are now considered emerging pathogens. Of the 11 currently recognized species, four have been implicated in human disease, although only two have been encountered in Europe.Bartonella quintana infections are now being diagnosed among the urban homeless and deprived, manifesting as trench fever, andBartonella henselae has been shown to be the causative agent of cat scratch disease. Both species also cause a variety of HIV-associated infections, including bacillary angiomatosis. However, perhaps the most significant presentation of bartonellae infection is culture-negative endocarditis. The epidemiologies ofBartonella infections are poorly understood; mostBartonella henselae infections are probably acquired from infected cats, either directly by contact with a cat or indirectly via fleas. No animal reservoir has been implicated forBartonella quintana; however, infection can be transmitted via the human body louse. Diagnosis ofBartonella infections can be made using histological or microbiological methods. The demonstration of specific antibodies may be useful in some instances, although certainly not in all. Cultivation ofBartonella is difficult, as the bacteria are extremely fastidious. Polymerase chain reaction-based or immunological methods for the detection of bartonellae in infected tissues have proven useful. Clinical relapse is often associated withBartonella infections despite a wide range of prescribed regimens. Only aminoglycosides display in vitro bactericidal activity against intracellularBartonella species; therefore, they are recommended for treatment ofBartonella infections.

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